I’ve heard the ladies get an injury-prevention boost that men don't from going barefoot. Is that true?

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The conclusion that women can reap extra benefits from running barefoot seems to lack a valid basis in substantive research.
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A:

A new study claims going barefoot has unique injury prevention benefits for women. We're not buying it—at least until there's more supporting research.

The study, led by an anatomy and physiology researcher from Trinity College in Dublin and published in Medicine & Science in Sports & Exercise, looked at the benefits of barefoot running versus running in shoes. Twenty-three different recreational female athletes ran on treadmills. First, the women ran wearing standard (neither minimalist nor maximalist) footwear, and then they ran barefoot, each time wearing devices that allowed the researchers to conduct a three-dimensional gait analysis afterward.

The results were surprising; subjects running barefoot showed less hip adduction (inward rotation), hip internal rotation, and pelvic drop (when hips sway from side to side, dropping one side down). These factors have been associated with injuries like IT band syndrome and patellofemoral syndrome, two problems women are particularly at risk for because the width of their hips can lead to increased stress on the knee during running. The authors concluded that barefoot running may help prevent these common running injuries in women.

But other experts aren't so sure."Some of the things that they were looking for in women—all of those things happen whether you’re a woman or a man when you’re sloppy and fatigued,” says Dr. Jon Woo, a sports medicine physician who runs a high-altitude running camp for elite athletes in Santa Fe, New Mexico. In other words, while the biomechanics the researchers examined could be important in relation to injury, they aren’t limited to women specifically. Any benefits—or negatives—from barefoot running would happen equally in women or in men. In fact, in his own practice, he hasn’t found a significant difference in men’s and women’s injuries at all. Instead, he’s seen greater differences between recreational and elite athletes: elite athletes get hurt because they overtrain and put in too many miles, and recreational athletes get hurt due to poor running form.

“I am of the camp that says, sure, in some runners using a minimalist shoe can be beneficial. But it all depends,” Woo said. “I feel that if gets people to be more aware of their running and their mechanics, it can be helpful. But I can say in general, if we put everybody barefoot we’re not going to have less injuries.”

While relatively few articles have been published examining barefoot running in relation to gender, the others that have were similarly skeptical about the benefits for women. A 2014 study published in the Journal of Science and Medicine in Sport, for example, looked at 18 healthy female runners and found that running in minimalist footwear increased pressure on the forefoot without actually changing from a rearfoot to a midfoot or forefoot strike, which is what barefoot running advocates say is one of the main benefits of minimalist/barefoot running.

“This increased pressure in the forefoot region might play a role in the occurrence of metatarsal stress fractures in runners who switched to minimalist shoes and warrants a cautious approach to transitioning to minimalist shoe use,” the authors wrote. Looking specifically at plantar pressure, the researchers didn’t find any benefits—and in fact found some risks—for running in minimalist shoes.

“You can read the science, but the proof is in the pudding,” said Dr. Karl Fields, Fellowship Director of Sports Medicine at Moses H. Cone Memorial Hospital in Greensboro, North Carolina. “When I went to races for or five years ago I would see people running in minimalist shoes, now I hardly see that at all. I think people are running into problems.”

After seeing upwards of 1,500 patients a year, many of them runners, Fields believes that gender differences in injury patterns are based on key variations in men’s and women’s physiologies, not in their running gait. According to Fields, women tend to have more problems in their feet, ankles, and with runner’s knee, possibly due to the hormonal effects of estrogen, whereas men are more prone to muscle strains due to lack of flexibility.

“I’m not opposed to people trying barefoot running, and I do use it in some therapy,” Fields said. “But for the average runner, I don’t think it’s very effective.” Most of the time, he says, the way to prevent injuries isn’t to buy a new type of shoe—or ditch the old pair—but instead to put in the hard work to build strength and improve your running form. For women with injuries, one of the first things he’ll do is give them a core- and hip-strengthening regimen to help make their gait more efficient.

So instead of worrying about your footwear, focus on getting strong instead. World Champion triathlete Craig Alexander’s core workout is a good start: